FORM 1023-EZ for HEALTH AND MEDICAL ACTIVISM OF LOUISVILLE

Field Data
EIN 85-3649793
Case Number EO-2020303-000426
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name HEALTH AND MEDICAL ACTIVISM OF LOUISVILLE
Organization’s Mailing Address 5704 HARRODS GLEN DRIVE
City PROSPECT
State KY
ZIP 40059
Accounting period End 12
Primary contact name AYSHA KHAN
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

AYSHA KHAN
CHIEF OPERATING OFFICER
5704 HARRODS GLEN DRIVE
PROSPECT KY 40059

Officer/Director/Trustee Two

SREEVATSA VEMURI
CHEIF EXECUTIVE OFFICER
5704 HARRODS GLEN DRIVE
PROSPECT KY 40059

Officer/Director/Trustee Three

SAFWA GOPANG
TREASURER
5704 HARRODS GLEN DRIVE
40059 KY 40059

Organization’s website
Organization’s email aysha.khan78643@gmail.com
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 1/29/2019
Organization Incorporation State KY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code S80 - Community Service Clubs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) Yes
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name AYSHA KHAN
Signature Title CHIEF OPERATING OFFICER
Signature Date 10/27/2020

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